Factors associated with having general medical "check ups" in a Caribbean country

OBJECTIVES: To determine the extent to which general `check ups' were sought by adult Jamaicans and to identify the demographic and health factors that would characterise individuals who utilized this service. DESIGN and METHODS: A national survey was conducted comprising Jamaicans age 15-50 years. Subjects were selected using a random sampling technique and respondents were interviewed using a structured questionnaire that included a number of demographic, health and behaviour variables. Multiple regression analyses were used to identify the independent predictors of having general 'check-ups'. RESULTS: Of the 3001 persons identified for study, 2580 persons were interviewed (86 percent). Nine hundred and twenty-six (926) (35.9 percent; 95 percent C1, 34.1-37.8 percent) persons said that they had general medical `check -ups. Of those who had check-ups, 33 percent had them at least once every 6 months, 34 percent every year and 33 percent less frequently. The independent predictors of having a check-up were being well educated (p<0.001, maried (p,0.001), more religious (p<0.001), female gender (p=0.001), being satisfied with life (p=0.009) and over 20 years of age (p=0.03). CONCLUSIONS: Having general medical `check-ups' was not an uncommon behaviour in this sample. More research is needed to further characterize and understand this phenomenon since this could be a route for improved preventive medicine and health education. (Au)

HIV infection rates and associated factors in high risk patients admitted to a psychiatric hospital in Trinidad and Tobago

We investigated the rate of HIV infection in patients at the St. Ann's psychiatric hospital in Trinidad and Tobago, and identified the demographic and clinical variables associated with infection. Patients admitted to the hospital were tested for HIV when details of their sexual history suggested that they might be at high risk of infection. We examined hospital records for the 1991-1995 period. During that time a total of 1,227 patients were tested, of whom 84 (6.9 percent) were confirmed positive for HIV. Since there was a total of 11,203 admissions over the period, the minimum infection rate for all patients was 0.75 percent. Among the high-risk group tested, being positive for HIV was associated with age (p=0.01) and ethnicity (p=0.003). The highest rates of infection were in the 15-44-year age group while the rates in patients of African and mixed ethnicity were higher than in East Indians. When the underlying diagnoses were examined, the highest rates were found in patients with substance abuse problems, especially those who abused cocaine (p<0.001). Patients who were VDRL reactive were also more likely to be HIV positive than other patients (p<0.001). These findings indicate that psychiatric patients are at greater average risk for HIV infection. Mental health specialists may need to be trained in sexual health counselling to facilitate preventive intervention for this high-risk group.(AU)

Perceptions about mental illness among pre-clinical medical students in Trinidad and Tobago

Perceptions about mental illness among medical practitioners are likely to determine their capacity to recognise, treat appropriately and refer patients who have mental health problems. It is therefore important that training of medical students in psychiatry is undertaken with knowledge of their attitudes to mental health disorders. We determined the perceptions of 108 pre-clinical medical students (69 males, 39 females; mean age 22 years) toward mental illness in Trinidad and Tobago by analysing their responses to a questionnaire based on a case vignette of a young man with a paranoid psychotic illness. 88 percent felt that medical treatment in hospital was the best means of treating the illness and 86 percent suggested that discharge should be conditional on regular visits to a doctor. 89 percent however opposed the patient's marrying into their families and 85 percent to his teaching their children. This was associated significantly with having a personal relationship with someone having a mental illnes (p < 0.03). Surprisingly, 25 percent believed that mental illness could be caused by supernatural forces, particularly females who were almost twice as likely as males to express this belief.(AU)

High rates of paraquat-induced suicide in southern Trinidad

The suicide rate in Trinidad and Tobago is much greater than that of its English-speaking Caribbean neighbors. Many of these suicides are paraquat induced. This research reviewed the deaths due to suicide in the area with the greatest agricultural activity in Trinidad for 1996 and identified, for further demographic and etiological investigation, cases in which paraquat was ingested as the agent of suicide. Of 48 cases of suicide for the year, 39 (81.3 percent) were due to paraquat poisoning. The incidence of paraquat-induced suicide was 8.0 per 100,000. Among the males, 47.8 percent were in the age group 25-34 (p< 0.001), and among the females 50.0 percent were in the 15-4 age group (p < 0.05). Family-of-origin disputes were the most frequently cited precipitant, folllowed by marital problems. Individuals of East Indian origin accounted for 89 percent of the suicide victims (p < 0.001). When compared with suicide by other methods in the country, these findings confirm that paraquat poisoning is a significant means of suicide in Trinidad and that young East Indian individuals are particularly vulnerable.(AU)

Psychiatric symptoms and an anterior cranial fossa meningioma

We present a case of a patient admitted to a psychiatric hospital with psychotic symptoms and cognitive impairment but who was subsequently found to have an anterior interhemispheric falx meningioma. There must be a high index of suspicion for organic brain disease in patients over age 45 years presenting with psychotic symptoms and seizures for the first time.(AU)

Paraquat induced suicide in Southern Trinidad

The rate of suicide in Trinidad and Tobago is much greater than in most of its Caribbean neighbours and self poisoning is the most common form of suicidal gesture. Paraquat poisoning in particular has been identified as one of the main agents of completed suicide. We therefore reviewed the deaths due to suicide in 1996 in South Trinidad, which is the area of Trinidad with the greatest agricultural activity, in an attempt to characterize paraquat induced suicide in terms of demographic and aetiological features. Case notes and clinical interviews were reviewed in all deaths due to deliberate self harm for the year 1996 at the General Hospital, San Fernando, Trinidad. There were 48 cases of completed suicide for the year and 39 (81 percent) of these were due to paraquat poisoning, giving an incidence of 8 per 100,000 population. Among the males, 48 percent were in the 25-34 year age group (p<0.001) and among the females 50 percent were in the 15-24 year age group (p<0.05). Family of origin disputes and marital problems were the most cited precipitants (p<0.003). Individuals of East Indian descent accounted for 89 percent of the cases (p<0.001). Psychiatric diagnoses were made in 20 percent of the cases with depression being the most frequently identified condition. While the ingestion of paraquat was often accompanied by heavy alcohol dependence. These findings confirm that paraquat poisoning continues to be a very significant problem and that young East Indian individuals seem particularly likely to attempt suicide by this means.(AU)

Is it necessary to distinguish between first and second generation African-Caribbean populaton in psychiatric research?

In attempting to identify factors responsible for the onset, course and prognosis of an illness, it is necessary to identify differences between generations in order to separate the effects of heritability and environment. Ethnicity and culture can also be examined in this way so that changes in culture occasioned by changes in environment can be assessed in terms of their impact on illness. In our work on the family history of psychoses among the African-Caribbean population in Britain we have found that for schrizophrenia, the relatives of first generation (those born in the Caribbean) and white psychotic patients share similiar risks while the risk is markedly increase in the relatives, particularly siblings of the second generation (those born in Britain to Caribbean parents) psychotic patients. For affective psychoses, we have found that the risk in the relatives of the first generation patients is significantly less than for both the white and the second generation relatives. These differences would have been much less noticeable if the separation between first and second generation patients had not been undertaken and would have been more difficult to interpret. Our findings do suggest that there are factors acting on the second generation making them more susceptible than their first generation counterparts to psychotic illness. This therefore diminishes the likelihood that the increased risk of illness in the second generation is due to a genetic effect and is much more likely to be mediated by some selective environmental effects acting either specifically on those families already afflicted by the disease or more generally on the entire second generation population.(AU)

A study of the ethnicity and the aetiology of schizophrenia - background and objectives

High rates of schizophrenia have been repeatedly reported among the African-Caribbean population in Britain. There has been no satisfactory explanation for these increased rates and while migrants in general are thought to be at increased risk, the incidence of schizophrenia is especially raised among African-Caribbean population that was born in Britain (second generation). Preliminary data from the Caribbean also suggest that there is a specific pathological process occuring in Britain. The available evidence in Britain also suggest that there are environmental factors which are selectively affecting the African-Caribbean population in Britain that are making them more vulnerable to schizophrenia. The study of high risk groups can be very instrumental in the elucidation of the aetiology of disease and therefore the study of this population may shed light on the aetiology of schizophrenia as a whole. In addition, this increased incidence of schizopherenia places a heavy demand both on the families of an already disadvantaged group as well as on the psychiatric services, particularly in the inner cities where the majority of African Caribbean people live in Britain. An understanding of the determinants of this increased risk of schizophrenia would lead to appropriate intervention strategies especially in the areas of prevention and provision of effective care. The study will be a population based case control study of the first contact schizophrenia in African-Caribbeans and the remaining population in three British centres. The research hypotheses are that the African-Caribbeans psychotic patients will show more evidence of risk increasing social factors, in particular adverse life events and a marked discrepancy between expectations and achievement. Their siblings will also show a high risk for psychosis suggesting that certain families are more susceptible to the social adversity associated with migration. The study will combine two strategies; the first to determine the absolute risk of the disorder, and the other to identify the risk factors which mediate the onset and course of the illness. We will also carry out a one year outcome study to examine the needs for mental health care in the African-Caribbean population and the extent to which treatment is appropriate.(AU)

HIV infection in a psychiatric hospital - abstract

This study sought to identify the characteristics of HIV positive patients in a psychiatric hospital in Trinidad and Tobago. HIV testing is done on patients admitted to the hospital who were at potentially high risk for HIV infections as identified by their behavioural history and clinical examination. Of the patients tested, 6.9 percent were HIV positive. There were no significant gender differences between positive and negative patients but there was an association with age. The highest prevalence was in the 35-44 year age group (9.7 percent) and the 15-24 year age group (8.3 percent). This was statistically significant (p=0.01). East Indians were significantly less likely to be HIV positive (p=0.003) when compared to Africans and those of patients of mixed descent. The prevalence of HIV infection was highest among those patients with a diagnosis of cocaine abuse or dependence (12.4 percent) compared with schizophrenia (3.3 percent), depression (3.9 percent) and dementia (8.1 percent) (p<0.001). These findings illustrate that among psychiatric patients, HIV infection may be associated with cocaine abuse and is more likely to be seen in patients of African and mixed descent. (AU)

Suicide in Trinidad and Tobago: associations with measures of social distress

Using national statistics for the period 1978-1992, associations were examined between suicide rates and measures of social distress in Trinidad and Tobago. The latter included unemployment, serious crimes, emigration rates and admissions to the country's psychiatric hospital. There was a 319 percent increase in male suicide rates, from 4.96/100,000 in 1978 to 20.76/100,000 in male suicide in 1992. Although there were fluctuations in the rate for females, it remained below 8/100,000. Over the 15 year period examined, there was a 51 percent increase in serious crime while male and female unemployment increase by 89 percent and 33 percent respectively. There was a 63 percent fall in the rate of permanent emigration while male and female admissions to the psychiatric hospital fell by 28 percent and 19 percent respectively. There were significant positive associations between male suicide and serious crimes as well as with male and female employment (p < 0.01). Male suicide rates were also negatively associated with male admissions to the psychiatric hospital (p < 0.01). Female suicide rates were positively associated with serious crime and male unemployment (p < 0.01). Although it is not possible to determine whether the observed associations were causal, the results suggest that social distress may be an important contributor to the suicide rate in Trinidad and Tobago, particularly among men. The organisation of preventive strategies for suicidal behaviour must therefore include measures to counter the experience of social distress in this setting(AU)

Morbid risk of schizophrenia in first-degree relatives of white and African-Caribbean patients with psychosis

The high rate of schizophrenia among the second-generation African-Caribbean population in Britain has prompted much concern and speculation. Sugarman and Craufurd have reported that the morbid risk in the siblings of second-generation African-Caribbean schizophrenic patients was unusually high compared with that of the siblings of white patients. METHOD: We sought to replicate these findings by comparing the morbid risk for schizophrenia in the first-degree relatives of 111 white and 73 African-Caribbean psychotic probands. The latter comprised 35 first-generation (born in the Caribbean) and 38 second-generation (born in Britain) probands. RESULTS: The morbid risk for schizophrenia was similar for the parents and siblings of white and first-generation African-Caribbean patients, and for the parents of the second-generation African-Caribbean probands. However, the siblings of second-generation African-Caribbean psychotic probands had a morbid risk for schizophrenia that was seven times that of their white counterparts (P = 0.007); similarly, the siblings of second-generation African-Caribbean schizophrenic probands had a morbid risk for schizophrenia that was four times that of their white counterparts (P = 0.05). CONCLUSIONS: These findings replicate those of the earlier report of Sugarman and Craufurd, and suggest either that the second-generation African-Caribbean population in Britain is particularly vulnerable to some environmental risk factors for schizophrenia, or that some environmental factors act selectively on this population in Britain.(AU)

Psychiatric disorder in systemic lupus erythematosus

The symptoms of systemic lupus erythematosus (SLE) may include altered mental function. The present study sought to examine whether the psychiatric disorders are due to the disease itself or to the stress of having a chronic disease. Forty-five SLE patients attending outpatient clinics at the Port of Spain General Hospital in Trinidad were compared with two control groups: patients with chronic debilitating diseases similar to SLE in terms of chronicity and treatment (n = 44) and non-diseased individuals (n = 48). The Structured Clinical Interview for DSM III-R was used to identify psychiatric disorders. Both the SLE and the chronic illness groups had more psychic illness (44 percent and 39 percent, respectively) when compared with the non-diseased controls (2 percent) (p<0.001). Major depression was the most common diagnosis among both diseased groups. However, the psychotic illnesses (schizophrenic-type psychosis and bipolar disorders) were more prevalent in the SLE group (11.1 percent vs 0 percent, p=0.02). These results indicate that major depression in SLE may be related more to the effects of a chronic illness than to SLE itself. However, the occurrence of psychotic symptoms may be related to SLE disease and needs further study. (AU)

Psychiatric disorder in systemic lupus erythematosus

The symptoms of systemic lupus erythematosus (SLE) may include altered mental function. The present study sought to examine whether the psychiatric disorders are due to the disease itself or to the stress of having a chronic disease. Forty-five SLE patients attending outpatient clinics at the Port of Spain General Hospital in Trinidad were compared with two control groups: patients with chronic debilitating diseases similar to SLE in terms of chronicity and treatment (n = 44) and non-diseased individuals (n = 48). The Structured Clinical Interview for DSM III-R was used to identify psychiatric disorders. Both the SLE and the chronic illness groups had more psychic illness (44 percent and 39 percent, respectively) when compared with the non-diseased controls (2 percent) (p<0.001). Major depression was the most common diagnosis among both diseased groups. However, the psychotic illnesses (schizophrenic-type psychosis and bipolar disorders) were more prevalent in the SLE group (11.1 percent vs 0 percent, p=0.02). These results indicate that major depression in SLE may be related more to the effects of a chronic illness than to SLE itself. However, the occurrence of psychotic symptoms may be related to SLE disease and needs further study.

Suicides in Trinidad and Tobago: associations with unemployment, crime and emigration

Death by suicide is an important public problem and efforts to identify its causes are needed so as to facilitate its prevention. Although mental illness is an established risk factor, the role of socioeconomic factors has not been explored. We, therefore, conducted an investigation to determine whether suicides in Trinidad and Tobago are related to social distress. Using national statistics for the period 1978 - 1992, associations were examined between suicide rates and unemployed, serious crimes and emigration rates. Over the 15-year period examined, there was a 319 per cent increase in male suicide rates, from 4.96/100,000 in 1978 to 20.76/100,000 in 1992. The rate in females was fairly constant remaining below 8/100,000 throughout the period. Over the same period there was a 51 per cent increase in serious crime, an 89 per cent increase in male unemployment and a 33 per cent increase in female unemployment. However, there was a fall in the rate of permanent emigration. Male, female and total suicide rates were significantly associated with serious crimes and unemployment (male, female and total). However, there was no association with emigration. The results of multiple regression analyses indicated that female unemployment was an independent predictor of male suicides while crime was an independent predictor of female suicides. Because of the design, the present study could not determine whether the observed associations were causal. However, the results suggest that at least some suicides in Trinidad and Tobago, during the period examined, may have been due to social distress. Programmes to ease this distress should have a positive effect on the suicide rate (AU)

Substance abuse in women and a past history of child abuse - abstract

The association between physical and/or sexual abuse and substance abuse in women has frequently been noted. This study sought to identify the frequency with which such a history of child abuse was reported by a group of females admitted to a treatment centre for substance abuse. All women (70) admitted in 1991 and 1992 to the Substance Abuse Prevention and Treatment Centre, Caura, Trinidad, were interviewed about the occurrence of either physical or sexual abuse in childhood or adolescence. All men (95) admitted for alcohol dependence were also interviewed and served as a comparison group. Twenty female clients (28.6 per cent) admitted to being abused as children, 36 (51.4 per cent) denied any history of child abuse while 14 (20 per cent) refused to respond. Subgroups of alcohol- and cocaine-dependent women gave similar frequencies of positive histories of child abuse (26.9 per cent and 29.6 per cent respectively). Only 12.6 per cent of male alcoholic admissions gave a positive history of child abuse and one-third (33.7 per cent) of the sample refused to respond to the question. There is a need to explore the issues relating to the physical and sexual abuse in childhood as it may be a factor in the pathogenesis of substance abuse in women. More detailed sexual assessment tools and treatment directed at the sequelae of child abuse may also be in this population (AU)

Shared-induced paranoid disorder Folie a deux between mother and son

A case of shared-induced paranoid (psychotic) disorder (DSM III-R, 1987) between mother and son is presented. This disorder may be a more frequently occurring disorder than is generally recognised. It is suggested that more detailed family and social investigations be undertaken to unearth pschopathology in the social environment of the patient. In cases involving relatives, this may be another dimension to the genetic influence on mental illness. This is the first case reported in the West Indian medical literature (AU)

Socio-demographic features of cocaine dependence: a pilot study - abstract

Cocaine use is epidemic in Trinidad and Tobago and is a cause of pressing social and health care concerns. This study reviews some socio-demographic features of the first 100 in-patients for cocaine dependence to the Substances Abuse Treatment Centre (SATC) in 1990. There were no females in this sample and 86 percent were between the ages of 20 and 39 years, 67 percent were either single, separated or divorced and 53 percent were employed at the time of admission. Forty-five per cent had a positive family history of substance abuse and 27 percent had been treated peviously for psychiatric illness other than substance abuse. In this sample, Africans accounted for 52 percent while East Indians contributed 26 percent. Interestingly, 70 percent of the patients admitted to using other drugs beside cocaine while 28 percent used cocaine only. Thirty-four per cent of the sample had been exposed to rehabilitation and treatment facilities prior to their admission to SATC and clinic follow-up with the urine testing revealed that 81 percent had relapsed by the end of six (6) months (AU)